Erectile dysfunction (ED) is the persistent loss of the ability to achieve or maintain a functional erection of sufficient rigidity for satisfactory penetrating sexual performance. ED is highly prevalent, and is estimated to affect 30 million men in the USA only. It may be a symptom of underlying, chronic illness (e.g. diabetes, peripheral vascular, and/or coronary heart disease) and can have a negative effect on the quality of life, the psychological health of the patient, and interpersonal relationships.
Modern management of ED allows a wide variety of approaches. The current therapeutic approaches to ED give the physician the tools to treat their patients in a stepwise fashion, going from the least invasive to the more invasive procedures. In general terms, today, the first line treatment of ED includes lifestyle modification, oral drug therapy (phosphodiesterase (PDE) inhibitors), and the use of vacuum assist devices for erection. Second line treatment offers intracavernosal papaverine or prostaglandin E1(PGE1) injections or intraurethral insertion of PGE1 pellets (Muse®) which cause relaxation of corporeal smooth muscles and enable erection. Although the second line approach has proved to be effective, in the long term many patients drop out especially because of the inconvenience of injecting drugs to the corpora cavernosa or inserting pellets into the urethra, their size, and the availability of effective oral agents.
SILDENAFIL, TADALAFIL, VARDEANFIL. VIAGRA. CIALIS. LEVITRA
The introduction of phosphodiesterase (PDE) inhibitors (sildenafil citrate (Viagra®), tadalafil (Cialis®), and vardenafil (Levitra®)) as effective oral agents for the treatment of ED (buy viagra online. where to buy viagra? ) hascaused major changes in its management. Although these medications have become the first line treatment for ED, they have proved to be effective in only 60–70% of ED sufferers, leaving a considerable number of patients who need to be treated by third line approaches. Third line treatments consist of surgical interventions which included penile revascularization, occlusion of venous leaks, and implantation of penile prostheses. However,vascular surgeries aimed to re-establish arterial blood flow or, by removing or ligating veins leaving the corpora cavernosa, prevent leakage during erection have been found to be ineffective in most cases. Because of this, penile revascularization procedures have become limited to young patients after pelvic trauma that may be amenable to a bypass procedure, and are mainly performed by vascular surgeons.